NCDs are the leading cause of death in almost every region of the world, and place a huge burden on individuals, families and societies. Humanitarian settings have a negative effect on the levels of disease, and the possibility of treatment. The importance of NCDs in global health is acknowledged by their inclusion in the Sustainable Development Goals, which call for a reduction of a third in premature mortality from NCDs by 2030. However, NCDs have until recently received little attention in humanitarian settings, leaving prevention, care and treatment needs largely unaddressed among some of the most vulnerable populations. According to the World Health Organization, 70 percent of global deaths are due to NCDs. The four main disease groups which cause the greatest number of deaths are cardiovascular disease, cancer, diabetes and chronic obstructive pulmonary disease (including asthma).
The course will provide knowledge about issues and dilemmas that occur around NCDs in humanitarian settings and possible solutions.
Why are NCDs a problem in humanitarian emergencies or crises? Natural disasters and complex emergencies, including armed conflict, have a negative effect on the levels of disease, and on the possibilities for preventing, treating and caring for people with NCDs. People living with NCDs often need continuous care to avoid disease progression, and disrupted treatment due to natural disaster or emergencies pose a large health challenge. In conflict situations and fragile contexts, the challenge of disrupted care and treatment may be exacerbated – an estimated 65 million people have been forcibly displaced by conflict, displacement lasts longer, and at times health systems and health personnel are deliberately targeted.

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Module 1: Why is it important?

In module one you will learn about why NCDs have increased in the world as a whole and about why NCDs are a particular problem in humanitarian emergencies or crises. Natural disasters and complex emergencies including armed conflict may have a negative effect, both on the levels of disease, and on the possibilities for preventing, treating or caring for people with NCDs.

Impartido por:

Siri Tellier

Lecturer

Transcripción

Kenya is one of many countries fighting a battle on two fronts, with a traditional infectious diseases on one side, and the increasing threat of non-communicable diseases on the other. In the last couple of years, I'll say roughly five years, the country has had a stage where we have both very high levels of infectious diseases, but also very increasing levels of non-communicable diseases. So, we have a 50-50 percent burden on both sides. The country has seen this transition that is now heavily affecting on the health care system. We're looking at a system that is still struggling with basics like malaria prevention and treatment. HIV and AIDS still a very heavy burden in the in the country, but at the same time we have increasing levels of cancers, of hypertension, of diabetes, and other cardiovascular conditions. So, this is weighing heavily on the health care system because the health care system wasn't prepared to be able to cope with this. For the non-communicable diseases, the high numbers that we are hypertension and diabetes. The latest survey that was done, the step survey that was done for the country, we were looking at 30-40 percent of the Kenyan population at risk of getting hypertension, and the actual prevalence of hypertension is 20 percent of the population. Then, we have diabetes that is at 3.1 percent of the total population. This is based on a sample survey, not a population-based survey. So, we expect the numbers to be more higher than this. Out of also a hospital analysis that was done, 27 percent of hospital mortalities are due to non-communicable diseases, which is very high comparing it even to diseases like HIV and AIDS that are causing less than 10 percent of the mortalities. So, we are looking at a situation where the non-communicable disease are now taking over the causes of mortalities in the country, and really taking up at a very high rate. The double burden of disease is also present inside Kenya's two refugee camps, Dadaab and Kakuma. To deal with this, the Kenyan Red Cross has recently, as the first humanitarian organization, initiated a non-communicable disease program inside the camps. Under the non-communicable disease program that we do in these two camps, we do screening, we do access to treatment, so we procure a lot of the drugs that then take care of persons living with the non-communicable diseases, and also provide the community level care and support services through community volunteers and health promoters. So, the Kenya Red Cross through support from different partners, we were the first ones to have a comprehensive NCD program going on, and covering just this smaller areas that we're looking at. So, it's still a big challenge considering that camps like Dadaab have been there for a long time. NCD problems and solutions are location specific. So, what are the main challenges in the refugee camps? For non-communicable diseases, the main challenge we have is access to treatment. It is still a big obstacle in terms of the populations, even accepting to do prevention, because one of the things which many people would talk about it being an ethical issue is, you would teach the community or make them aware of the conditions, then you will take them through screening, then after screening, then what? That is now the discussion that is going on. Availability of drugs is still a big challenge in our country because of cost implications. Most of the non-communicable disease drugs are very expensive. Access is a challenge to most of the people who get themselves with some of these conditions. That is one of the biggest challenges. The second challenge is the capacity of the health care workers. Most of our health care workers training was really heavily based on infectious diseases. It's not only a Kenyan problem, it's a global problem. Well, we are looking at health workers who have been trained heavily on infectious diseases with very little training on non-communicable diseases. So, you have very few specialists. These few specialists are accessible to very few people. So, you have a lot of misdiagnosis happening. You have a lot of misprescriptions being provided. So, by the time somebody realizes you are diabetic, maybe you've been treated for all kinds of conditions. Then, also we do have, of course, challenges in terms of community awareness also. There's still a lot that needs to be done in terms of educating the community on what are these NCD's, how do you get them, and how do you then prevent yourself from getting them? How do you manage yourself to be able not to either get, or if you have the condition, then how do you take care of yourself? So, patient education is also one thing that needs to be looked at. So, I would look at it from that perspective in terms of capacity of the health care workers, access to treatment, because of the cost, the drugs are still very expensive. Then, looking at the level of community awareness of the non-communicable diseases. As many other lower middle income countries, Kenya's health system has barely managed to solve the challenges of infectious diseases such as tuberculosis, malaria, HIV/AIDS. So, how is the Kenyan Red Cross prioritizing the resources when having to do with the NCD's as well? It is a huge challenge to actually prioritize when you have a double burden of disease, and all of them causing very heavy overload on the health care system. So, you're looking at how to equip especially the health workers to be able to balance the two and prioritize the terms of service provision, but also looking at what are the high impact interventions to be done. I think that is what also helps us a lot. So, we look at, for example, for non-communicable diseases, what are the best based, the high impact interventions to do? Then, you also look at for the other infectious diseases. So, adopting an integrated model that would be focusing on high impact best base I think is the model that now we are taking. So, for example, we do a lot of community level interventions, and we work with community health volunteers, who we then are forced to train them on a number of things. But then, even as we are training them on those number of things, then we equip them to be able to do some of the key interventions that can help reduce both sides of the disease burden. So, they go into the community to do a malaria treatment, but then they're able to do a glucose test, they are able to do a blood pressure tests, and they are able to refer the patients for help. So, using an integrated model is what helps in being able to address the double burden. As we have heard, the double burden adds a strain on the health system. So, what had been the most important lessons learned from the first four years of the NCD program? I think for the last four years where there's been quite a bit of noise being made around non-communicable diseases, one of the things we've learned is looking at really priority setting, especially supporting the government to priority set which areas to focus on. The other lesson that I've also learned in the process is looking at how to make decision makers be influenced and do more targeted budgeting, and incorporate some of these conditions in their budgeting. But then, also just looking at the important role that the community and the patient place in terms of ensuring that they're taking care of themselves. So, patient empowerment is very important because at times some of these populations are on the move. The refugee populations are on the move. Here, you are providing a long-term, for example, diabetes treatment to a patient. If you don't teach that patient how to take care of themselves, the patient will move to another camp or another station or go back to Somalia. It becomes very difficult to track what is going to happen to them when they leave or when they move elsewhere. So, patient education and empowerment becomes a very, very essential tool to support these patients as they move. Then, also just looking at also training people around them, the caregivers, to be able to support them in the process, because that becomes a very important service delivery point for the person's living with NCD's.